Specifics of acute coronary syndrome associated with atrial fibrillation in real world clinical practice (based on the registry of the Krasnodar Region)

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Abstract

Background: Coronary heart disease is the most common cardiovascular disorder, while atrial fibrillation (AF) is the most common heart arrhythmia.

Aim: To perform a comparative analysis of the coronary substrate assessed by coronary angiography in patients with acute coronary syndrome (ACS) in combination with various AF types, as well as to analyze abnormal electrocardiographic findings and blood troponin levels in patients with ACS and AF versus ACS patients with sinus rhythm.

Materials and methods: We retrospectively analyzed medical files 13,244 ACS patients entered into the total ACS registry in the Krasnodar Region from 20.11.2015 to 20.11.2017. In 1204 (9%) of them ACS was associated with AF (ACS + AF group, n = 119), the remaining 12 040 (91%) patients had sinus rhythm (ASC + SR group, n = 120).

Results: Compared to the ACS + SR group, the troponin levels were significantly (р ≤ 0,05) higher in the ACS + AF group. No statistically significant differences between two groups were found for localization of hemodynamically significant coronary stenoses at coronary angiography. Only 25.0% (p = 0.1689) of patients with ACS + AF without ischemic electrocardiographic changes (ST depression or elevation) had no hemodynamically significant coronary stenoses at coronary angiography.

Conclusion: AF in ACS patients is an important factor in the course of the disease and is characterized by higher blood troponin levels and significantly more frequent absence of ischemia-related electrocardiographic changes, compared to the ACS patients with sinus rhythm.

About the authors

Z. G. Tatarintseva

Scientifc Research Institute – S.V. Ochapovsky Regional Clinic Hospital No 1

Author for correspondence.
Email: tatarintsev_m@mail.ru

Zoya G. Tatarintseva – MD, Head of the Cardiology Department

167 1st May ul., Krasnodar, 350086

Russian Federation

E. D. Kosmacheva

Scientifc Research Institute – S.V. Ochapovsky Regional Clinic Hospital No 1;
Kuban State Medical University

Email: fake@neicon.ru

Elena D. Kosmacheva – MD, PhD, Deputy Chief Physician, Scientifc Research Institute – S.V. Ochapovsky Regional Clinic Hospital No 1; Head of the Chair of Therapy No 1, Postgraduate Training Faculty, Kuban State Medical University

167 1st May ul., Krasnodar, 350086, 

4 Sedina ul., Krasnodar, 350063

Russian Federation

S. A. Raff

Scientifc Research Institute – S.V. Ochapovsky Regional Clinic Hospital No 1;
Kuban State Medical University

Email: fake@neicon.ru

Stanislav A. Raff – MD, PhD, Chief of the Cardiology Unit No 1, Scientifc Research Institute – S.V. Ochapovsky Regional Clinic Hospital No 1; Associate Professor, Chair of Therapy No 1, Postgraduate Training Faculty, Kuban State Medical University

167 1st May ul., Krasnodar, 350086, 

4 Sedina ul., Krasnodar, 350063

Russian Federation

S. V. Kruchinova

Scientifc Research Institute – S.V. Ochapovsky Regional Clinic Hospital No 1;
Kuban State Medical University

Email: fake@neicon.ru

Sofya V. Kruchinova – MD, Cardiologist, Scientifc Research Institute – S.V. Ochapovsky Regional Clinic Hospital No 1; Postgraduate Student, Chair of Therapy No 1, Postgraduate Training Faculty, Kuban State Medical University

167 1st May ul., Krasnodar, 350086, 

4 Sedina ul., Krasnodar, 350063

Russian Federation

V. A. Porkhanov

Scientifc Research Institute – S.V. Ochapovsky Regional Clinic Hospital No 1

Email: fake@neicon.ru

Vladimir A. Porkhanov – Member of Russian Academy of Sciences, MD, PhD, Professor, Chief Physician

167 1st May ul., Krasnodar, 350086

Russian Federation

References

  1. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfsterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall EE, Vrints CJ; ESC Committee for Practice Guidelines, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S; Document Reviewers, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949–3003. doi: 10.1093/eurheartj/eht296.
  2. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P; ESC Scientifc Document Group. 2016 ESC Guidelines for the management of atrial fbrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38): 2893–962. doi: 10.1093/eurheartj/ehw210.
  3. Голухова ЕЗ, Шумилина МВ, Кабисова АК. Ишемическое повреждение структур мозга и когнитивные нарушения у пациентов с фибрилляцией предсердий. Креативная кардиология. 2018;12(1):31–9. doi: 10.24022/1997-3187-2018-12-1-31-39.
  4. Burokienė N, Domarkienė I, Ambrozaitytė L, Uktverytė I, Meškienė R, Karčiauskaitė D, Kasiulevičius V, Šapoka V, Kučinskas V, Kučinskienė ZA. Classical rather than genetic risk factors account for high cardiovascular disease prevalence in Lithuania: A cross-sectional population study. Adv Med Sci. 2017;62(1):121–8. doi: 10.1016/j.advms.2016.08.005.
  5. Abidov A, Hachamovitch R, Rozanski A, Hayes SW, Santos MM, Sciammarella MG, Cohen I, Gerlach J, Friedman JD, Germano G, Berman DS. Prognostic implications of atrial fbrillation in patients undergoing myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol. 2004;44(5): 1062–70. doi: 10.1016/j.jacc.2004.05.076.
  6. AFFIRM Investigators. Atrial Fibrillation Follow-up Investigation of Rhythm Management. Baseline characteristics of patients with atrial fbrillation: the AFFIRM Study. Am Heart J. 2002;143(6):991–1001. doi: 10.1067/mhj.2002.122875.
  7. Hohnloser SH, Crijns HJ, van Eickels M, Gaudin C, Page RL, Torp-Pedersen C, Connolly SJ; ATHENA Investigators. Effect of dronedarone on cardiovascular events in atrial fbrillation. N Engl J Med. 2009;360(7):668–78. doi: 10.1056/NEJMoa0803778.
  8. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KA, Califf RM; ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fbrillation. N Engl J Med. 2011;365(10):883–91. doi: 10.1056/NEJMoa1009638.
  9. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fbrillation. N Engl J Med. 2009;361(12):1139–51. doi: 10.1056/NEJMoa0905561.
  10. Schmitt J, Duray G, Gersh BJ, Hohnloser SH. Atrial fbrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. Eur Heart J. 2009;30(9):1038–45. doi: 10.1093/eurheartj/ehn579.
  11. Alasady M, Abhayaratna WP, Leong DP, Lim HS, Abed HS, Brooks AG, Mattchoss S, Roberts-Thomson KC, Worthley MI, Chew DP, Sanders P. Coronary artery disease affecting the atrial branches is an independent determinant of atrial fbrillation after myocardial infarction. Heart Rhythm. 2011;8(7):955–60. doi: 10.1016/j.hrthm.2011.02.016.
  12. Stenestrand U, Lindbäck J, Wallentin L; RIKSHIA Registry. Anticoagulation therapy in atrial fbrillation in combination with acute myocardial infarction influences long-term outcome: a prospective cohort study from the Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA). Circulation. 2005;112(21):3225–31.
  13. Lopes RD, Pieper KS, Horton JR, Al-Khatib SM, Newby LK, Mehta RH, Van de Werf F, Armstrong PW, Mahaffey KW, Harrington RA, Ohman EM, White HD, Wallentin L, Granger CB. Short- and long-term outcomes following atrial fbrillation in patients with acute coronary syndromes with or without ST-segment elevation. Heart. 2008;94(7):867–73. doi: 10.1136/hrt.2007.134486.
  14. Jabre P, Jouven X, Adnet F, Thabut G, Bielinski SJ, Weston SA, Roger VL. Atrial fbrillation and death after myocardial infarction: a community study. Circulation. 2011;123(19): 2094–100. doi: 10.1161/CIRCULATIONAHA.110.990192.
  15. GRACE Investigators. Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project: a multinational registry of patients hospitalized with acute coronary syndromes. Am Heart J. 2001;141(2):190–9. doi: 10.1067/mhj.2001.112404.
  16. Kundu A, O'Day K, Shaikh AY, Lessard DM, Saczynski JS, Yarzebski J, Darling CE, Thabet R, Akhter MW, Floyd KC, Goldberg RJ, McManus DD. Relation of atrial fbrillation in acute myocardial infarction to in-hospital complications and early hospital readmission. Am J Cardiol. 2016;117(8):1213–8. doi: 10.1016/j.amjcard.2016.01.012.
  17. Kanjwal K, Imran N, Grubb B, Kanjwal Y. Troponin elevation in patients with various tachycardias and normal epicardial coronaries. Indian Pacing Electrophysiol J. 2008;8(3):172–4.
  18. Tsigkas G, Kopsida G, Xanthopoulou I, Davlouros P, Koutsogiannis N, Makris G, Theodoropoulos K, Kassimis G, Gkizas V, Hahalis G, Alexopoulos D. Diagnostic accuracy of electrocardiographic ST-segment depression in patients with rapid atrial fbrillation for the prediction of coronary artery disease. Can J Cardiol. 2014;30(8):920–4. doi: 10.1016/j.cjca.2014.03.023.
  19. Androulakis A, Aznaouridis KA, Aggeli CJ, Roussakis GN, Michaelides AP, Kartalis AN, Stougiannos PN, Dilaveris PE, Misovoulos PI, Stefanadis CI, Kallikazaros IE. Transient ST-segment depression during paroxysms of atrial fbrillation in otherwise normal individuals: relation with underlying coronary artery disease. J Am Coll Cardiol. 2007;50(19):1909–11. doi: 10.1016/j.jacc.2007.08.005.
  20. Pradhan R, Chaudhary A, Donato AA. Predictive accuracy of ST depression during rapid atrial fbrillation on the presence of obstructive coronary artery disease. Am J Emerg Med. 2012;30(7):1042–7. doi: 10.1016/j.ajem.2011.06.027.
  21. Matusik PT, Prior SM, Butenas S, Małecka B, Lelakowski J, Undas A. Association of cardiac troponin I with prothrombotic alterations in atrial fbrillation. Kardiol Pol. 2018;76(7):1106–9. doi: 10.5603/KP.2018.0134.
  22. Elabbassi W, Chowdhury MA, Brano Liska, Hatala R. Clinical profle and angiographic fndings among patients with atrial fbrillation presenting for selective coronary angiography. Health (NY). 2014;6(1):44–50. doi: 10.4236/health.2014.61007.
  23. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alferi O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH. Guidelines for the management of atrial fbrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369–429. doi: 10.1093/eurheartj/ehq278.
  24. Shakir DK, Arafa SO. Right atrial infarction, atrial arrhythmia and inferior myocardial infarction form a missed triad: a case report and review of the literature. Can J Cardiol. 2007;23(12): 995–7. doi: 10.1016/S0828-282X(07)70864-4.
  25. Lokshyn S, Mewis C, Kuhlkamp V. Atrial fbrillation in coronary artery disease. Int J Cardiol. 2000;72(2):133–6. doi: 10.1016/S0167-5273(99)00180-1.
  26. Motloch LJ, Reda S, Larbig R, Wolff A, Motloch KA, Wernly B, Granitz C, Lichtenauer M, Wolny M, Hoppe UC. Characteristics of coronary artery disease among patients with atrial fbrillation compared to patients with sinus rhythm. Hellenic J Cardiol. 2017;58(3):204–12. doi: 10.1016/j.hjc.2017.03.001.
  27. Kirchhof P, Bax J, Blomstrom-Lundquist C, Calkins H, Camm AJ, Cappato R, Cosio F, Crijns H, Diener HC, Goette A, Israel CW, Kuck KH, Lip GY, Nattel S, Page RL, Ravens U, Schotten U, Steinbeck G, Vardas P, Waldo A, Wegscheider K, Willems S, Breithardt G. Early and comprehensive management of atrial fbrillation: executive summary of the proceedings from the 2nd AFNET-EHRA consensus conference 'research perspectives in AF'. Eur Heart J. 2009;30(24):2969–77c. doi: 10.1093/eurheartj/ehp235.
  28. Twerenbold R, Jaffe A, Reichlin T, Reiter M, Mueller C. High-sensitive troponin T measurements: what do we gain and what are the challenges? Eur Heart J. 2012;33(5):579–86. doi: 10.1093/eurheartj/ehr492.
  29. Weber M, Bazzino O, Navarro Estrada JL, de Miguel R, Salzberg S, Fuselli JJ, Liebetrau C, Woelken M, Moellmann H, Nef H, Hamm C. Improved diagnostic and prognostic performance of a new high-sensitive troponin T assay in patients with acute coronary syndrome. Am Heart J. 2011;162(1):81–8. doi: 10.1016/j.ahj.2011.04.007.

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Copyright (c) 2018 Tatarintseva Z.G., Kosmacheva E.D., Raff S.A., Kruchinova S.V., Porkhanov V.A.

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